The Impact of Cat Fostering on Older Adult Well-Being and Loneliness: A Feasibility Study.

OBJECTIVES: This feasibility study explored the impact of fostering a shelter cat on loneliness and well-being in older adults living alone without a pet. The study also examined the effect of cat fostering on older adults' interest in cat adoption when perceived barriers to adoption were removed. METHODS: A total of 29 adults (age ≥60) were paired with a cat and asked to foster for a minimum of 4 months (with an option to adopt). Participants completed surveys before placement with cats, with a follow-up at 1 and 4 months postplacement and 12 months if they adopted their cat. The survey included scales of loneliness, physical and mental health, self-efficacy, positive and negative affect, and comfort from a companion animal. Scores were compared across time using a Multivariable Linear Mixed Model. RESULTS: A total of 23 of 29 (79.3%) participants remained in the study for at least 4 months, and a majority (95.7%) adopted their cat. Differences in marginal means (adjusted for physical health) showed a significant improvement in loneliness from baseline to 4 months (p = .029). A similar 4-month improvement that approached statistical significance (adjusted p = .079) was observed for mental health. No other scales showed statistically significant changes across time. DISCUSSION: Fostering a shelter cat with the option for adoption may be an effective solution for alleviating loneliness and improving mental health in older adults. Interest in adopting foster cats was high when perceived barriers to adoption were removed.

Gender differences in coping with long-term COVID-19 impacts among older adults.

Initial COVID-19 pandemic research suggests that during the first few weeks of the pandemic women were disproportionately impacted by restrictions compared to men. This study explored whether these gender differences in coping with pandemic restrictions were present among older adults 8-9 months into the COVID-19 pandemic. Data are based on online survey responses (n = 781) from respondents aged 60 and older. The survey was fielded from November 2 to December 4, 2020. Compared to older men, a greater proportion of older women self-reported an increase in being lonely, anxious, scared, sad, stressed, hopeless, and frustrated as compared to the beginning of the pandemic. More women reported engaging in healthy coping behaviors compared to men and self-reported more decreases in sleeping and in eating compared to the first few weeks of the pandemic. A greater proportion of older women reported a decline in physical activity since the first few weeks of the pandemic compared to older men. Self-reported changes in communication did not differ by gender, except for text messaging. More women compared to men reported that their use of text messaging increased since the initial stages of the pandemic. Results showed significant gender differences among older adults in coping with long-term COVID-19 restrictions 8-9 months into the pandemic.

"At First It Wasn't so Bad": How Adults Aged 60 and Older Feel About Social Distancing During COVID-19.

We conducted an exploratory study to describe the emotional experience of adults aged 60 and older in the United States practicing social distancing during COVID-19. The survey asked respondents how they were feeling during social distancing. Responses (n=673) were coded into segments by affect and then specific emotional states. A large portion of respondents reported negative emotions (e.g. anxiety, loneliness). A smaller portion reported positive emotions (e.g. optimism, gratitude). Younger respondents (aged 60-70) reported more feelings of anxiousness and fear compared to older respondents (71+). Older respondents were more likely to report negative feelings towards the government. For both age groups, female respondents were significantly more likely to report feeling afraid and having negative feelings about their own health. We conclude that many older adults are vulnerable to negative emotional outcomes during the pandemic. This highlights the importance of interventions targeting vulnerable older adults.

Linguistic Isolation and Mortality in Older Mexican Americans: Findings from the Hispanic Established Populations Epidemiologic Studies of the Elderly.

Purpose: Limited English proficiency and increased language isolation are known to be associated with adverse health outcomes. It is not clear how neighborhood-level linguistic isolation may impact individual health and risk of death among Hispanic older adults. We examined the link between living in a linguistically isolated neighborhood and all-cause mortality among an older Mexican American cohort. Methods: Using a longitudinal sample of older Mexican Americans from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly, we calculated the days from the baseline interview (1993-1994) until observed death through five waves of follow-up (until 2004-2005) using Cox regression. A linguistically isolated neighborhood was defined as a census tract with more than 30% of linguistically isolated households. Results: Our results showed that living in a neighborhood with more than 30% of linguistically isolated households predicted higher mortality (hazard ratio: 1.25; 95% confidence interval: 1.04-1.50), after adjusting for age, sex, nativity, years of education, marital status, self-reported health status, number of chronic conditions, ever smoked, ever drank, and other neighborhood-level contextual factors. Conclusion: Living in a neighborhood with a high proportion of linguistically isolated households predicted higher mortality among older Mexican Americans. Addressing the social capital shortage in linguistically isolated neighborhoods is one way to address health disparities in the United States.

Exploring Contextual Factors Associated with Suicide among Older Male Farmers: Results from the CDC NVDRS Dataset.

Objectives: The purpose of this study was to explore how demographic, relationship, mental health, and life stressors are associated with suicide among older male farmers and to determine if these differ by age.Methods: We conducted exploratory analyses with Centers for Disease Control (CDC) National Violent Death Reporting System (NVDRS) 2003-2017 dataset. We identified individuals who completed suicide while working in agriculture (N = 2,106). We explored descriptive statistics for farmers who completed suicide and compared these by age using chi-square tests.Results: The majority of the sample was male, non-Hispanic, and White. Marital status differed significantly by age, with older farmers more likely to be married or widowed. Having a mental health issue was not statistically significant by age; however, depression was most prevalent among those 65+. Older farmers who completed suicide were also significantly more likely to report physical health problems.Conclusions: Results illustrate the vulnerability of individuals contemplating suicide and emphasize the need to consider the phenomenon from a holistic perspective that accounts for individuals nested within community.Clinical implications: We recommend health providers consider a systems approach to suicide prevention as our results indicate individual, familial, and societal factors contributing to the incidence of suicide completion among older farmers.

Gender differential impact of bereavement on health outcomes: evidence from the China Health and Retirement Longitudinal Study, 2011-2015.

BACKGROUND: Bereavement is the experience of an individual following the death of a person of significance to the individual, most often referring to the spouse. Increased morbidity, health care utilization, and mortality are known to be associated with bereavement. Given China's growing population of older adults, there is a critical need to assess the health consequences of bereavement. METHOD: We use data from the China Health and Retirement Longitudinal Study to examine the impact of bereavement on mental health and quality of life among a sample of mid- and older-aged adults. We use propensity score matching to construct a matching sample and difference-in-differences method to estimate the impact of bereavement on mental health and self-assessed health. RESULTS: We find bereavement is associated with increased depression symptoms among women (1.542 point or 0.229 standard deviations of Center for Epidemiologic Studies Depression (CES-D) 10 score) but not consistently for men over time. No statistically significant effect of bereavement on self-assessed health is found. CONCLUSIONS: Our results show a harmful impact of bereavement on mental health among older women in China and point to the need for a comprehensive policy on survivor benefits in China, particularly for rural older women.

Coping with being cooped up: Social distancing during COVID-19 among 60+ in the United States.

OBJECTIVES: This study examined the impact of sheltering in place and social distancing among adults aged 60 and older during the 2020 outbreak of COVID-19 in the United States. METHODS: Using convenience sampling respondents were asked to complete a web-administered survey to explore impact of social distancing on loneliness, stress, and behavioral changes. The analytic sample consisted of 833 responses of persons aged 60 and older. RESULTS: A large portion reported being stressed (36%), and/or being lonely (42.5%). Nearly 1/3 stated that their sense of loneliness increased during the time of social distancing. Respondents reported engaging in more solitary activity (and fewer in-person activities), using email and text messages more than usual, and spending more time on computers/tablet than usual. Approximately 2/3 reported using more social media than usual. These differed significantly by younger (age 60-70) and older (71+) respondents. Additionally, changes in physical activity, drinking, recreational drug use and sleeping pattern changes differed by age. CONCLUSIONS: Social distancing has significant consequences on loneliness and health behaviors among adults in the United States, many of which differ by age group. Results have implications for continued shelter in place practices, but also for any older adult that may be homebound for other reasons.

OBJETIVOS: Evaluar el impacto de la indicación de quedarse en casa y el distanciamiento social en los adultos de 60 años o más durante el brote de COVID-19 en los Estados Unidos en 2020. MÉTODOS: Utilizando un muestreo de conveniencia, se solicitó a los destinatarios que completaran una encuesta administrada por internet para explorar el impacto del distanciamiento social respecto de la soledad, el estrés y los cambios de comportamiento. La muestra analizada consistió en 833 respuestas de personas de 60 años o más. RESULTADOS: Una proporción importante de la muestra informó experimentar estrés (36%) o soledad (42,5%). En alrededor de un tercio de los casos se informó que la sensación de soledad aumentó durante el período de distanciamiento social. Los encuestados informaron que realizaban más actividades solitarias y menos actividades presenciales, utilizaban el correo electrónico y los mensajes de texto más de lo habitual y pasaban más tiempo que lo habitual con sus computadoras o tabletas. Aproximadamente dos tercios de las personas que respondieron informaron que utilizaban las redes sociales más que lo habitual. Se observaron diferencias significativa entre los encuestados más jóvenes (60-70 años) y los mayores (>71). Los cambios en la actividad física, el consumo de alcohol y de drogas recreativas y los cambios en los patrones de sueño también difirieron según la edad. CONCLUSIONES: El distanciamiento social tiene consecuencias significativas respecto de la soledad y los comportamientos que afectan a la salud en los adultos mayores de los Estados Unidos, muchas de los cuales varían según el grupo etario. Los resultados tienen implicaciones respecto de la indicación sostenida de quedarse en casa, así como para otros adultos mayores que deban estar confinados a su hogar por razones distintas a la pandemia.

Coping with being cooped up: Social distancing during COVID-19 among 60+ in the United States

[ABSTRACT]. Objectives. This study examined the impact of sheltering in place and social distancing among adults aged 60 and older during the 2020 outbreak of COVID-19 in the United States. Methods. Using convenience sampling respondents were asked to complete a web-administered survey to explore impact of social distancing on loneliness, stress, and behavioral changes. The analytic sample consisted of 833 responses of persons aged 60 and older. Results. A large portion reported being stressed (36%), and/or being lonely (42.5%). Nearly 1/3 stated that their sense of loneliness increased during the time of social distancing. Respondents reported engaging in more solitary activity (and fewer in-person activities), using email and text messages more than usual, and spending more time on computers/tablet than usual. Approximately 2/3 reported using more social media than usual. These differed significantly by younger (age 60-70) and older (71+) respondents. Additionally, changes in physical activity, drinking, recreational drug use and sleeping pattern changes differed by age. Conclusions. Social distancing has significant consequences on loneliness and health behaviors among adults in the United States, many of which differ by age group. Results have implications for continued shelter in place practices, but also for any older adult that may be homebound for other reasons.

[RESUMEN]. Objetivos. Evaluar el impacto de la indicación de quedarse en casa y el distanciamiento social en los adultos de 60 años o más durante el brote de COVID-19 en los Estados Unidos en 2020. Métodos. Utilizando un muestreo de conveniencia, se solicitó a los destinatarios que completaran una encuesta administrada por internet para explorar el impacto del distanciamiento social respecto de la soledad, el estrés y los cambios de comportamiento. La muestra analizada consistió en 833 respuestas de personas de 60 años o más. Resultados. Una proporción importante de la muestra informó experimentar estrés (36%) o soledad (42,5%). En alrededor de un tercio de los casos se informó que la sensación de soledad aumentó durante el período de distanciamiento social. Los encuestados informaron que realizaban más actividades solitarias y menos actividades presenciales, utilizaban el correo electrónico y los mensajes de texto más de lo habitual y pasaban más tiempo que lo habitual con sus computadoras o tabletas. Aproximadamente dos tercios de las personas que respondieron informaron que utilizaban las redes sociales más que lo habitual. Se observaron diferencias significativa entre los encuestados más jóvenes (60-70 años) y los mayores (>71). Los cambios en la actividad física, el consumo de alcohol y de drogas recreativas y los cambios en los patrones de sueño también difirieron según la edad. Conclusiones. El distanciamiento social tiene consecuencias significativas respecto de la soledad y los comportamientos que afectan a la salud en los adultos mayores de los Estados Unidos, muchas de los cuales varían según el grupo etario. Los resultados tienen implicaciones respecto de la indicación sostenida de quedarse en casa, así como para otros adultos mayores que deban estar confinados a su hogar por razones distintas a la pandemia.

A Mixed-Methods Approach to Understanding the Palliative Needs of Parkinson's Patients.

Parkinson's disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.

Coping with being cooped up: social distancing during COVID-19 among 60+ in the United States / Afrontamiento de la cuarentena y el distanciamiento social durante la pandemia por COVID-19 en los mayores de 60 años en los Estados Unidos

ABSTRACT Objectives. This study examined the impact of sheltering in place and social distancing among adults aged 60 and older during the 2020 outbreak of COVID-19 in the United States. Methods. Using convenience sampling respondents were asked to complete a web-administered survey to explore impact of social distancing on loneliness, stress, and behavioral changes. The analytic sample consisted of 833 responses of persons aged 60 and older. Results. A large portion reported being stressed (36%), and/or being lonely (42.5%). Nearly 1/3 stated that their sense of loneliness increased during the time of social distancing. Respondents reported engaging in more solitary activity (and fewer in-person activities), using email and text messages more than usual, and spending more time on computers/tablet than usual. Approximately 2/3 reported using more social media than usual. These differed significantly by younger (age 60-70) and older (71+) respondents. Additionally, changes in physical activity, drinking, recreational drug use and sleeping pattern changes differed by age. Conclusions. Social distancing has significant consequences on loneliness and health behaviors among adults in the United States, many of which differ by age group. Results have implications for continued shelter in place practices, but also for any older adult that may be homebound for other reasons.(AU)

RESUMEN Objetivos. Evaluar el impacto de la indicación de quedarse en casa y el distanciamiento social en los adultos de 60 años o más durante el brote de COVID-19 en los Estados Unidos en 2020. Métodos. Utilizando un muestreo de conveniencia, se solicitó a los destinatarios que completaran una encuesta administrada por internet para explorar el impacto del distanciamiento social respecto de la soledad, el estrés y los cambios de comportamiento. La muestra analizada consistió en 833 respuestas de personas de 60 años o más. Resultados. Una proporción importante de la muestra informó experimentar estrés (36%) o soledad (42,5%). En alrededor de un tercio de los casos se informó que la sensación de soledad aumentó durante el período de distanciamiento social. Los encuestados informaron que realizaban más actividades solitarias y menos actividades presenciales, utilizaban el correo electrónico y los mensajes de texto más de lo habitual y pasaban más tiempo que lo habitual con sus computadoras o tabletas. Aproximadamente dos tercios de las personas que respondieron informaron que utilizaban las redes sociales más que lo habitual. Se observaron diferencias significativa entre los encuestados más jóvenes (60-70 años) y los mayores (>71). Los cambios en la actividad física, el consumo de alcohol y de drogas recreativas y los cambios en los patrones de sueño también difirieron según la edad. Conclusiones. El distanciamiento social tiene consecuencias significativas respecto de la soledad y los comportamientos que afectan a la salud en los adultos mayores de los Estados Unidos, muchas de los cuales varían según el grupo etario. Los resultados tienen implicaciones respecto de la indicación sostenida de quedarse en casa, así como para otros adultos mayores que deban estar confinados a su hogar por razones distintas a la pandemia.(AU)

Pain as a Risk Factor for Loneliness Among Older Adults.

OBJECTIVE: The objective of this is to examine whether pain is associated with the onset of loneliness in a sample of community-dwelling older adults. METHODS: We used data from the 2008 and 2012 Health and Retirement Study. We limited the sample to community-dwelling persons aged 60 years and over who were not lonely in 2008 in order to predict the risk of onset of loneliness (incidence) in 2012. Our analytic sample included 1,563 observations. RESULTS: Approximately 31.7% of participants reported loneliness at follow-up (2012). Logistic regression models showed that the odds of loneliness onset was 1.58 higher for those with pain at both time points, compared with those who had pain at neither time point, even after controlling for other covariates. DISCUSSION: The results indicate that pain may increase the risk of loneliness in older adults. This suggests that appropriate pain interventions could prevent future loneliness, which in turn could prevent functional decline, disability, and premature mortality.

Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients.

BACKGROUND: A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients. AIM: To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson's disease patients and their reported referral practices. DESIGN: A cross-sectional survey study of neurologists. SETTING/PARTICIPANTS: A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology's clinician database. RESULTS: Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = -16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral. CONCLUSION: Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services.

Background: The majority of older adults prefer to remain in their homes, or to "age-in-place." To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults' residential environment is associated with their health status and HCBS utilization. Building upon the Person-Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.

Physical Activity and Cardiovascular Disease Among Older Adults: The Case of Race and Ethnicity.

The goals of this study were (1) to test the relative contribution of light intensity and moderate-to-vigorous intensity physical activity (MVPA) to cardiovascular disease (CVD) risk in older adults, and (2) to examine the influence of ethnicity. We used pooled data from the 2003-2004 and 2005-2006 waves of the National Health and Nutritional Examination Survey (NHANES). The sample consisted of 1,171 non-Hispanic White, non-Hispanic Black, and Mexican American adults aged 65 and older. Using ordinary least squares regression, we showed no statistically significant relationship between lower CVD risk with light intensity activity. However, greater minutes of MVPA was associated with lower CVD risk. Mexican Americans had statistically significantly higher risk for CVD compared to non-Hispanic Whites after controlling for physical activity. Mexican Americans remain an at-risk group for CVD. Regardless of race or ethnicity, physical activity recommendations among elders should be for at least moderate intensity activity for a more favorable CVD outcome.

Exploring Changes in Two Types of Self-Efficacy Following Participation in a Chronic Disease Self-Management Program.

Chronic conditions and falls are related issues faced by many aging adults. Stanford's Chronic Disease Self-Management Program (CDSMP) added brief fall-related content to the standardized 6-week workshop; however, no research had examined changes in Fall-related self-efficacy (SE) in response to CDSMP participation. This study explored relationships and changes in SE using the SE to manage chronic disease scale (SEMCD Scale) and the Fall Efficacy Scale (FallE Scale) in participants who successfully completed CDSMP workshops within a Southern state over a 10-month period. SE scale data were compared at baseline and post-intervention for 36 adults (mean age = 74.5, SD = ±9.64). Principal component analysis (PCA), using oblimin rotation was completed at baseline and post-intervention for the individual scales and then for analysis combining both scales as a single scale. Each scale loaded under a single component for the PCA at both baseline and post-intervention. When both scales were entered as single meta-scale, the meta-scale split along two factors with no double loading. SEMCD and FallE Scale scores were significantly correlated at baseline and post-intervention, at least p < 0.05. A significant proportion of participants improved their scores on the FallE Scale post-intervention (p = 0.038). The magnitude of the change was also significant only for the FallE Scale (p = 0.043). The SEMCD Scale scores did not change significantly. Study findings from the exploratory PCA and significant correlations indicated that the SEMCD Scale and the FallE Scale measured two distinct but related types of SE. Though the scale scores were correlated at baseline and post-intervention, only the FallE Scale scores significantly differed post-intervention. Given this relationship and CDSMP's recent addition of a 10-min fall prevention segment, further exploration of CDSMP's possible influence on Fall-related SE would provide useful understanding for health promotion in aging adults.

The Role of Age in Moderating the Association Between Disability and Light-Intensity Physical Activity.

PURPOSE: There's a lack of evidence on the association between light-intensity physical activity and disability. This study examines the relationships in activity by self-reported physical function in five domains (i.e., activities of daily living [ADL], instrumental ADL, leisure activities, lower extremity, and general activities), and whether this association varies by age. DESIGN: Cross-sectional. SETTING: Data from National Health and Nutrition Examination Survey 2003-2004 and 2005-2006 waves. SUBJECTS: Participants included 5700 men and women ages 20 to 85 years. MEASURES: Difficulty with various activities was measured with the Physical Functioning Questionnaire, accelerometer-measured physical activity, demographics, and self-rated health. ANALYSIS: Ordinary least squares regression models were run to examine the relationship between physical function in each domain, light-intensity activity, and the moderating effect of age. Analyses controlled for body mass index, moderate-to-vigorous-intensity activity, self-reported health, accelerometer wear time, and gender. RESULTS: Little variation was seen in light-intensity physical activity among younger adults regardless of disability status. Older adults reporting difficulty with activities engaged in significantly less light-intensity physical activity compared to those with no disability (271.8 vs. 316.5 minutes). Age significantly moderated the association between light-intensity physical activity and leisure activities (p = .048), and lower extremity mobility (p = .039). Age did not moderate other domains of disability. CONCLUSION: Younger age may be protective regarding the influence of disability on light-intensity activity. In addition, disability may be more debilitating for some older individuals. Interventions to increase light-intensity activity should aim to address disability at all ages, with increased attention for older adults.

In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years.

In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87%). A report of any loss increases risk of health care utilization by 20% to 30%. For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.

Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults.

OBJECTIVES: We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. METHODS: We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. RESULTS: Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (ß = 0.075, SE = 0.034). Loneliness was not significantly associated with hospitalizations. CONCLUSIONS: Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs.

Cross-National Differences in Disability Among Elders: Transitions in Disability in Mexico and the United States.

OBJECTIVES: Little is known about how exposure to a combination of infectious and chronic conditions throughout the lifecourse could impact disability in old age. This paper compares 2 cohorts of adults who have aged under very different country contexts by contrasting disability transitions among elders in Mexico with elders in the United States. METHODS: Data comes from the Mexican Health and Aging Study (MHAS) and the U.S. Health and Retirement Study (HRS). Estimated probabilities of 2-year transitions among disability states and mortality are presented for adults aged 50 and older. RESULTS: The levels of disability prevalence and 2 year transitions are consistent with a higher rate of disability for the United States compared to Mexico. In 2-year transitions, the U.S. sample was more likely to transition to a disabled state or increase the number of disabilities than the Mexican counterparts, while Mexicans are more likely to move out of disability or reduce the number of disabilities reported. DISCUSSION: The findings suggest that the current rate of disability in old age is lower for a less developed country compared with a developed society. We discuss implications, possible explanations, and likely future scenarios.